From the Guidelines
The next best step in managing a patient with acute pericarditis following a motor vehicle collision (MVC) who has stable vital signs is to initiate aspirin or NSAIDs therapy as first-line treatment, with consideration of adding colchicine as an adjunct therapy, while also conducting a thorough diagnostic work-up to rule out specific causes of pericarditis, such as bacterial or neoplastic causes, and to assess for high-risk features that may necessitate hospital admission 1.
Diagnostic Work-up
The diagnostic work-up should include:
- Auscultation
- ECG
- Echocardiography
- Chest X-ray
- Routine blood tests, including markers of inflammation (i.e., CRP and/or ESR) and myocardial lesions (CK, troponins)
- Additional testing should be related to the suspected origin and clinical presentation 1.
Treatment
The treatment should be guided by the presence of high-risk features, such as fever, subacute course, large pericardial effusion, or cardiac tamponade, and the response to initial therapy.
- Aspirin or NSAIDs are recommended as first-line therapy for acute pericarditis, with a usual dosing of 750-1000 mg every 8 hours for aspirin, and 600 mg every 8 hours for ibuprofen, for 1-2 weeks, with tapering by decreasing doses by 250-500 mg every 1-2 weeks 1.
- Colchicine is recommended as an adjunct to aspirin or NSAIDs, with a dosing of 0.5 mg twice daily for patients ≥ 70 kg, and 0.5 mg once daily for patients < 70 kg, for 3 months 1.
- Corticosteroids should be considered for acute pericarditis in cases of contraindication or failure of aspirin/NSAIDs and colchicine, and when an infectious cause has been excluded, or when there is a specific indication such as autoimmune disease, with a recommended dose of 0.2-0.5 mg/kg/day of prednisone or equivalent 1.
Hospital Admission
Hospital admission is recommended for high-risk patients with acute pericarditis, including those with fever, subacute course, large pericardial effusion, or cardiac tamponade, and those with failure of aspirin or NSAIDs therapy 1.
Follow-up
Follow-up should include regular assessment of symptoms, CRP levels, ECG, and echocardiogram, with consideration of exercise restriction until resolution of symptoms and normalization of CRP, ECG, and echocardiogram 1.
From the Research
Diagnosis and Treatment of Acute Pericarditis
- The diagnosis of acute pericarditis requires at least two of the following criteria: new or worsening pericardial effusion, characteristic pleuritic chest pain, pericardial friction rub, or electrocardiographic changes, including new, widespread ST elevations or PR depressions 2.
- Transthoracic echocardiography should be performed in all patients with acute pericarditis to characterize the size of effusions and evaluate for complications 2.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) are the first-line treatment option for acute pericarditis, with colchicine used in combination with NSAIDs to reduce the risk of recurrence 2, 3, 4.
Management of Acute Pericarditis Following a Motor Vehicle Collision (MVC)
- In patients with stable vital signs, the next best step in managing acute pericarditis following a MVC would be to initiate treatment with NSAIDs and consider the use of colchicine to reduce the risk of recurrence 2, 3, 4.
- It is essential to monitor the patient's condition and adjust the treatment plan as needed, with consideration for hospital admission if there is a higher risk of complications 2, 3.
Considerations for Treatment
- Glucocorticoids should be reserved for patients with contraindications to first-line therapy and those who are pregnant beyond 20 weeks' gestation or have other systemic inflammatory conditions 2.
- Interleukin 1 (IL-1) blockers may be used for selected patients with multiple recurrences as steroid-sparing therapy 3.
- The treatment plan should be tailored to the individual patient's needs, with consideration for the underlying cause of the pericarditis and any potential complications 5.